Well done @LillyPad making insulin affordable to many more Americans left stranded by America’s health insurance system. $35/month max for anyone with private insurance or no insurance. And what’s really great about this patient assistance program is that it eats into the...
...deductible as if the patient had paid full list price. So this plan makes other diabetes products (or anything) more affordable for patients by helping them get past their deductible to the copay phase of insurance. It’s still possible that an insurance plan will combat...
...this feature of the Lilly plan by imposing a copay accumulator, which would only reveal the heartless, vindictive nature of some insurance plans in trying to deter patients from getting the care they need by making them suffer higher out of pocket costs than many can afford.
Too bad America’s government blocks anyone on Medicare from benefiting from such patient assistance programs. Drug companies still help them by donating to non-profits who help patients, & then companies get vilified for circumventing gov efforts to make care unaffordable.
At least during the covid crisis, Congress should lift the ban on drug companies offering Medicare patients help with their out of pocket costs directly and simply, as this Lilly plan now does for younger people with diabetes.
Until we have insurance reforms that extend coverage to all Americans (doesn’t have to be Medicare for all... though Medicare would be better than nothing for those who have nothing), all of the drug industry should make their drugs available for free or cheap to the uninsured...
...and continue to offer generous assistance programs to those with Swiss cheese private insurance plan that don’t make drugs affordable. As for hospital costs, US Gov recently promised to paying medical costs of all uninsured during covid; that should be extended beyond covid.
Nothing about healthcare is affordable without health insurance that actually makes appropriate care affordable (with low or no out of pocket costs). As for society getting value, we need competition (not consolidation) among healthcare providers to keep services costs down...
...& we need to invest in more drugs (& help people stay healthy in other ways) to prevent hospitalizations. Price controls on new drugs would discourage investment in innovation to make more new drugs, & besides drugs already have price controls that make them cost effective...
...because they go generic. Drugs going generic is the price control we’ve long had and what we need to continue to enforce. Some drugs don’t go generic on-time (due to patent gaming) or at all (due to their complexity, eg gene therapy).
As I proposed in my book TheGreatAmericanDrugDeal.com we need reforms such as contractual genericization to ensure that America gets value from all drugs, the way a family gets value from paying off a mortgage by living in their home rent free.
Drugs are unique in all of healthcare in that they go generic & become inexpensive. Hospitals & surgeries never go generic... they are eternal rent. Lilly’s modern insulin analogs are indeed due to go generic (biosimilar) but have remained expensive...
...for longer than needed to incentivize their development. They are a good example of drugs that should have been contractually genericized by now. But Lilly & other companies have many newer drugs that merit having society make mortgage payments for them until they go generic.
These mortgage payments for branded drugs all add up to just 1.3% of our economy and support 5m jobs in biomedical innovation. We can afford it, but only collectively via insurance/taxes, not making few patients pay out of pocket.
Congress must ensure that drug companies and our insurance system serve patients by setting clear rules. All drugs must go generic when it’s their time (see McSally bill) and all Americans must have proper insurance w/o excessive out of pocket costs.
Note on Lilly plan: I don’t see any loopholes to the Lilly assistance program. It looks comprehensive. They have annual $7500 threshold on what Lilly pays per person to detect fraud (eg pharmacy charging too much, for multiple prescription), but if you hit that cap, just call.
Some will say “this should have come sooner”. Yes! It should have. And it should apply to all drugs. And all drug companies should do this. Covid is prompting needed reforms that will hopefully last forever.
If you are wondering how the industry will afford subsidizing all these costs, the answer is simple. To balance its own budgets, whenever any portion of the global market pays less (whether Europe or uninsured Americans), the rest of the market...
...pays more (in premiums and taxes). That’s how it should be. The drug industry doesn’t systematically price gouge (yes, some cases). It’s profit margins are 10-15% when you look at all companies (not just the most profitable large one- most companies have no profits!).
So if not for the revenues it generates from insurance plans paying for drugs, there would be no industry, no innovation. People like to think the polio vaccine was a shining example of altruism, but it followed the rules of economics too and...
...the companies that manufacturered that vaccine had patents and only made the vaccine because they weren’t asked to lose money doing so. People need paying jobs and that’s only possible when society pays for their products.
So if we want innovation (yes! now more than ever), then let’s not pretend that it’s free, but let’s not burden just the vulnerable amongst us who need care today to pay the mortgage for products that serve us all. Insurance paid for by all should make care free to patients.
If America paid for fire protection the way that it does for healthcare, then the fire department that makes everyone in a town feel more secure would pay its bills by charging a high copay to anyone whose house was burning... and if you couldn’t pay, they would let it burn.
That’s not how we pay for the security of having a fire department that insures us against fire and it’s not how we should be paying for a healthcare system that makes us feel less scared about getting sick.
So thank you @LillyPad. Let’s see more of this same heart from all companies. And Congress & Media let’s not pretend innovation can be had without investment. No more talk of price controls on new drugs. Make sure they all go generic! That’s the price control we can rely on.
As for affordability, it’s always been about insurance. Covid is revealing that. Patient assistance from drug companies is a patch; we need proper insurance reforms in America to cover everyone and lower out of pocket costs.
